Устные экзаменационные темы для лечебного и педиатрического факультетов 2011-2012 уч год

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Устные экзаменационные темы для лечебного и педиатрического факультетов 2011-2012 уч. год

  1. Describe the main components of the undergraduate medical education in Russia and in Great Britain. What are the differences and similarities?

  2. Describe GP's practice team and GP's working day.

  3. Discuss the problem of missed appointments. Suggest the problem solutions.

  4. List the main methods of the patient examination. What analyses and instrumental investiga tions should be carried out for making a correct diagnosis?

  5. Describe the hospital team. What are the responsibilities of different specialists?

  6. Describe history taking.

  7. Describe the work of a typical chemist's shop. What departments does it include? What types of medication do you know? In what doses are they prescribed? What should the doctor re member when prescribing drags?

  8. Discuss the problem of the clinical drug trials. What is your opinion on using animals for re search? Should prisoners or sick people agree to participate in such trials?

  9. Discuss what people should/shouldn't do to lead healthy lifestyle.

  10. Discuss the importance of keyhole surgery. What complications and risks does it reduce?

  11. Discuss the importance of pre-operative procedures. List them. What are the benefits of pre- op patient education, both for patient and for the healthcare system?

  12. Describe the procedure of conventional surgery. What personnel are involved? What instru ments are necessary? What documents does the orderly take into theater?

  13. Discuss the importance of post-operative monitoring. What complications may occur? Ex plain how to rate and manage pain.

  14. Describe Great Britain: geographical position, political situation, population, nations, history and the main sights.

  15. Advertise N.N. Burdenko Medical Academy (Alma Mater) so that foreign students would like to study there.

  16. Discuss the problem of infectious diseases transmission. What are the main transmission routes? What are the ways of its prevention?

  17. Describe some of the infectious diseases (causes, symptoms, detection, and treatment).

  18. Discuss the work of an ambulance team and the cases that may be attributed to emergency.

  19. What is triage? Describe main triage categories.

  20. Explain the importance of following hygiene rules at a hospital. What are the results of poor hygiene at a hospital? Discuss how epidemics in hospitals may be managed.

1.Medical education in Great Britain

Medical education in Great Britain is provided at medical schools - the section of a university. Young people are admitted to a medical school on the basis of their performance in the school examinations at an advanced level.

Medical education in Great Britain is provided on a fee-paying basis. Most students receive financial assistance in the form of grants and scholarships.

Undergraduate education lasts four or five years.

Usually it includes 2 years of pre-clinical training and 3 years of clinical work at a teaching hospital. At the pre-clinical stage students cover basic sciences, such as Ajiatomy, Biology, Biochemistry, Physiology, Statistics and Genetics.

Students attend lectures, do dissections and practical work in labs. They are ijivolved with patients from the very beginning. Even in their first year they spend much time in hos­pital. Much of the course is PBL (Problem Based Learning). They have two sessions a week where they work in groups of eight to ten solving clinical problems. They decide together how to tackle the problem, look up books and online sources, make notes and discuss the case together. They consider it a great way of learning and getting to know the otfier stu­dents. Now it's mainly group work, although they do have some lectures and seminars, where they work in small groups with a tutor. They get to cut up cadavers from the second month of the course.

So Core (Years 1-3) is an integrated programme of clinical and scientific topics mainly presented through problem based learning (PBL), where they work or study with others in series of case problems.

During years 4 and 5 they've got a series of four-week clinical attachments щ Gen­eral Medicine, Surgery, Psychological Medicine, Child Health, Obstetrics and Gynecology, Pharmacology, Community Medicine and General Practice. They also study methods of clinical observation and history taking.

Medical students have practical training in teaching hospitals. They employ the methods of clinical examination and history taking. The students attend ward rouqds and follow up their patients.

Between years 4 and 5 Student Selected Modules (SSMs) allow them to choose from a menu of subjects such as Sports Medicine or even study a language as preparation for an overseas elective, a hospital attachment ofyour own choice

.The component of Vocational Studies and Clinical Skills prepares students for the clinical skills required for contact with patients from Year 1 of their course, through periods of practical training where they are attached to a hospital department or general practice.

At the end of the course of study young specialists obtain the degrees of a Bachelor of Medicine or Bachelor of Surgery. These degrees allow the graduates continue tlAeir edu­cation during a two-year Foundation Programme.

Assessment of their knowledge includes written, clinical and oral test and examina­tions. The final exams are in Medicine, Surgery, Pathology and Obstetrics and Gynecology.

It provides training for new doctors through the series of placements in different spe­cialties such as General medicine, General Surgery, Pediatrics, Anesthetics and others.

The Foundation Programme forms the bridge between university-level study a,t medi­cal school, and specialist or general practice training. It consists of a series of placements, each lasting four months, which allow the junior doctor, known as trainee, to sample differ­ent specialties, for example pediatrics. A year one trainee (FY1) corresponds |o pre- registration house officer (PRHO) posts and a year 2 trainee (FY2) to senior house officer posts. Each trainee has an educational supervisor who ensures that more senior doctprs de­liver training in different ways, including clinical and educational supervision. To prpgress, trainees have to demonstrate a range of clinical competencies which are assessed through observation in their workplace.

A higher degree of a Master of Medicine is awarded after further study.

After final examinations having received their university degree in medicine gradu­ates serve as house officers under the supervision of senior doctors. After a year of this training programme new doctors become registered by the General Medical Council and can practice medicine.

Post-graduate training is for doctors who want to become GPs or consultants (senior specialists). Post graduate training in Great Britain is delivered through colleges for differ­ent specialties.

Medical education in Great Britain also covers continuing professional development in the form of courses and seminars.

Doctors doing research obtain a PhD (Doctor of Philosophy) or MD (Doctor of Medicine) degree.

^ 2. Describe GP's practice team.

Is it typical for Russian outpatient department?

A typical GP practice employs receptionists. They are responsible for ini­tial patient contact, making appointments, taking request for repeat prescriptions, taking messages from patients and other health care providers, for filing and scanning documents into patient records. The practice manager has responsibility for finance, he also supervises reception staff, hires locums and helps to prepare the practice development plan. Practice nurses run asthma, diabetes and cardio­vascular disease clinics as well as one-to-one clinics for those who wish to give up smoking.

In addition to practice staff, GPs work with a number of health profession­als. For example, district nurses visiting temporarily housebound patients, such as recently discharged hospital patients. Health visitors visit families to carry out check-ups on young children - particularly under-fives - to make sure they are healthy. Special attention is paid to families in need, such as those living in pov­erty. They also do baby immunizations.

Midwives run clinics for antenatal patients. Physiotherapists provide hands-on treatment but also teach patients exercises they can do to improve their condition after an accident or operation.

As you see, GP's practice team represents the whole system, in which every specialist plays his definite part. That is why it is twice important for GP to choose members of his team thoroughly. Such a team is not typical for Russian outpatient Department. That is why work of a district doctor in Russia may be more complicated.3. Discuss the problem of missed appointments. Suggest the problem solutions.

Ln a busy general hospital it may be very difficult to arrange the hospital work in order to correspond to the highest level of organization. That is why it is twice important for the hospital staff to set up an appointment schedule.

There is a great variety of appointments stated by the patients or their doctors. For example, when patients phone up to say they cannot keep their appointment, it is called cancelled. In contrast, if patients tell the doctor they will definitely keep their appointment, it is called confirmed. The initial appointment of the patient means that this is the first time the patient sees the doctor. When consultant or patient is running late, the appointment may be postponed. A regular appointment is also called routine. When two people are given the same appointment time, their appointment would be double-booked. If an appointment slot is available, it is usually called vacant.

Among these types of appointments there is the most problematical one. This is a missed appointment, when a patient doesn't turn up. Appointments missed by some patients represent danger both for the other patients and for medical staff, which is responsible for the hospital regimen.

I think the most reasonable way to solve the problem of missed appointments is system of notification. It means that patients are reminded of their forthcoming appointment the day before it. The other way of solving this problem is the system of penalties, which may be imposed in case of missed appointment. Thus, the size of the penalty is directly proportional to the quantity of appointments, missed by a patient. But even if in this case patient doesn't turn up, his vacant appointment may be replaced by some other patient's, if it is possible. And then a doctor must be afraid of appointing a consultation to the shirker, as he's not a reliable person to deal with.

In order to arrange an appointment without any problem it also may be necessary for the patient to fill up the appointment form carefully. Hospital administration always maintains privacy of any medical problem of the patients. That is why patient should make his appointment in advance to get his date of choice confirmed

.^ 4. List the main methods of the patient examination. What analyses and instrumental in­vestigations should be carried out for making a correct diagnosis?

Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record.

For determining a disease it is very important to know its symptoms such as breathlessness, edema, cough, vomiting, fever, haemorrhage, headache and others. Some of these symptoms are objective, for example, haemorrhage and vomiting, as they are determined by objective study, while others, for example, headache and dizziness, are subjective since they are evident only to the patient.

Clinical examination of the patient, also known as executive physicals, typically includes labora­tory tests, chest X-rays, pulmonary function testing, audiograms, full body CAT scanning, EKGs, heart stress tests, vascular age tests, urinalysis, and mammograms or prostate exams depending on gender.

^ Computed tomography (CT) is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. The scanner takes up to 16 simultaneous cross-sectional images (slices). Each slice can be less than one millimeter thick making it possible to find very small abnormalities. CT scanning of the head is typically used to detect infarction, tumours, calcifications, haemorrhage and bone trauma. Of the above, hypodense (dark) structures indicate infraction or tumours, hyperdense (bright) structures indicate calcifications and haemorrhage and bone trauma can be seen as disjunction in bone windows.

^ Electrocardiography (ECG or EKG) is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes. It is a noninvasive recording produced by an electrocardiographic device.

Magnetic resonance imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is pri­marily a medical imaging technique most commonly used in radiology to visualize detailed internal structure and limited function of the body. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurologi­cal, musculoskeletal, cardiovascular and oncological imaging. Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field to align the nuclear magnetization of hydrogen atoms in water in the body.

^ The chest X-ray examination is the commonest diagnostic X-ray examination. Normally a frontal view is obtained. During this procedure the patient stands facing the photographic plate. Radiographer, the technician who takes the X-ray, asks the patient not to move, then to breathe in deeply and not to breathe out. This method is used to see abnormalities in air-filled lungs.

^ Ultrasound examination uses high-frequency sound waves to view organs and structures inside the body. The waves are generated and received by a hand-held device called transducer. The reflected waves are processed by a computer, which produces detailed images for display of a monitor. Ultrasound as safe as it doesn't employ ionizing radiation like X-rays.

A complete physical examination includes evaluation of general patient appearance and specific organ systems. It is recorded in the medical record in a standard layout which facilitates others later reading the notes. In practice the vital signs of temperature examination, pulse and blood pressure are usually measured first.

^ 5. Describe the hospital team. What are the responsibilities of different specialists?

In a busy general hospital there may be several thousand staff on the payroll. Although they are a tea.il that works closely together. Team members don't have equal status but function within a complicated system of ranks and grades. The medical hierarchy is well known for its strict divisions and class structure.

The basic hospital chain of command in British hospitals remains unchanged and is represented by pi к

consultant, registrar, senior house officer and the house officer.

A senior house officer (SHO) is a junior doctor undergoing training within a certain speciality. SHOs are supervised by consultants and registrars, who oversee their training and are their designated clinical su­pervisors. A doctor typically works as an SHO for 2-3 years, or occasionally longer, before becoming a reg­istrar. A registrar is a doctor who is receiving advanced training in a specialist field of medicine in order to become a consultant. A consultant typically leads a "firm" (team of doctors) which comprises specialty regis­trars, and foundation house officers, all training to work in the consultant's specialty, as well as other "career grade" doctors such as clinical assistants, clinical fellows and staff grade doctors.

In the UK primary care - the first contact with hospital team - is often provided by general practitio­ners and nurses called health visitors. General practitioner treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating peo­ple with multiple health issues and comorbidities.

When it comes to recoveiy care and corrective treatment, other members of the team with special expertise come into the picture. These are professionals such as surgeons, physiotherapists, anesthetists, car­diologists, paediatricians, radiologists and others. Such professionals work in hospital specialist departments. Big general hospitals may have up to 50 specialist departments, for example, Coronary, Dermatology, Gas- troenterology, Genitourinary, Haematology, Obstetrics, Rheumatology, Gynaecology and Ophthalmology. Because barriers are breaking down between ancient and modern views of illness, many hospitals now en­courage interaction with complementary medicine, so it is now common for acupuncturists and masseurs to have a part to play too.

The whole structure of hospital team is kept going by the ancillary staff - the lab technicians, mid- \ ives, paramedics, porters, cleaners and scrub nurses. A paramedic is a medical professional, usually a member of the emergency medical services, who primarily provides pre-hospital advanced medical and trauma care. Midwifery is a health care profession in v/hich providers offer care to childbearing women dur­ing their pregnancy, labour and birth, and during the postpartum period, a practitioner of midwifery is known as a midwife. Porter is a person who carries some things; he also helps the invalids to move around the hos­pital on the carriage. Cleaners and scrub nurses provide medical hygiene practice.

The ancillary staff is an important force of individuals whose contribution to the effectiveness of hospital work is often underestimated.

As you see, hospital team represents the whole system, in which every specialist carries out his own function and has his own responsibilities

.^ 6. Describe history taking

The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroan- amnesis), with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient.

History-taking may be comprehensive - a fixed and extensive set of questions, as practised only by medical students, or iterative hypothesis testing, where questions are limited and adapted to rule in or out likely diagnoses based on information already obtained, as practised by busy clinicians. Medical students are taught to follow a structured guide when learning how to take a medical history on the wards. Computer­ised history-taking could be an integral part of clinical decision support systems.

As soon as the patient seeks medical attention a doctor fills in the patient's case his­tory. A full case history covers: personal details, presenting complaint, chief complaint, review of systems, past medical history, drug history, family history, patient's expecta­tions and others.

Normally, patient's personal details have been entered in their records by a nurse or administrative staff before the doctor sees them. However, on later consultations a doctor may wish to check details such as address, date of birth or occupation. Personal details may also include social history describing living arrangements, marital status, number of children, recent foreign travel, and exposure to environmental pathogens through recreational activities or pets.

The doctor also must know if any of the family has ever been ill with tuberculosis or has had any mental or emotional impairments. These findings are devoted to the family history.

The patient's medical history must also include the information about the diseases with the patient had both being a child and an adult, about the operations which were performed, about the traumas he had. These findings compose the past medical history.

The attending doctor must know what the patient's complaints and symptoms are. He must know how long and how often the patient has had these complaints. This part of taking a history is called presenting complaints.

The other integral part of case history is drug history. It is essential for the doctor to obtain full details of all drugs and medications taken by the patient. It is necessary to determine the precise identity of the drug, the dose used, the frequency of administra­tion and the patient's compliance and lack of it. The case history must always be written very accurately and consist of exact and complete information.

The information obtained in this way, together with clinical examination, enables the physician to form a diagnosis and treatment plan. If a diagnosis cannot be made, a provisional diagnosis may be formulated, and other possibilities (the differential diagnoses) may be added, listed in order of likelihood by convention. The treatment plan may also include further investigations to clarify the diagnosis.

7.Text A

AT THE CHEMIST'S Chemists' shops are specialized shops where medicines are sold. Chemists' shops are usually situated on the ground floor. They have a hall for visitors, two departments for selling drugs, and proper working rooms.

The department for reception of prescriptions and delivery of drugs is called a prescription department. The other one is called a chemist department. At the prescription department medicines are sold or made up according to prescriptions. At the chemist department one may buy medicines without prescriptions. In this department one may buy also different things for medical care and medicinal plantsA J

The working rooms of a chemist's include rooms for washing, drying and sterilization of glassware, an analytical laboratory, a room for storing medicines, a room for dispensing them and some others.

At the chemist's all medicines are kept in drug cabinets, on the open shelves and in the refrigerator. Poisonous drug are kept in the drug cabinet with the letter A. Strong effective drugs are kept in the drug cabinets having the letter B.

The drugs prepared at the chemist's for immediate use should be kept in the refrigerator. Powders, galenical preparations and medicines produced at the pharmaceutical plants are usually kept on the shelves protected from light at a constant temperature, not higher than a room temperature.

Every small bottle or box has a label with the name of the medicine. There are labels of four colours for the drugs prepared at the chemist's: labels of a green colour indicate medicines for internal use; blue labels indicate drugs used for injections. Drugs for external application have labels of a yellow colour. Drugs used for treatment of eye diseases have labels of a pink colour.j

The single dose and the total dosage are indicated on the label or the signature. The directions for the administration of a drug are very important for sick people as well as for those who take care of them.

At the chemist department medicines are kept according to the therapeutic effect: drugs for cough, cardiac medicines, drugs for headache. Disinfectants, herbs and things for medical care such as hot-water bottles, medicine droppers, cups, thermometers are kept separately.

At the prescription department one can see drugs of all kinds: boxes and parcels of different powders, ampoules of glucose and camphor used for intramuscular and intravenous injections; tubes of ointments for rubbing; different pills and tablets for internal use; tonics and sedatives administered orally.

The personnel of an average chemist's consists of a manager of the chemist's, a dispensing pharmacist who takes prescriptions and delivers drugs, a chemist controlling the prescriptions, that is, physical, physico-chemical and pharmacological compatibility of the ingredients of the compound prescribed by the physician. The personnel includes also a chemist-analyst who controls effectiveness of the drug prepared at the' chemist's as well as that of manufactured drugs. There is also a pharmacist who is in charge of the supply of necessary medicines.

chemist department - отдел ручной продажи poisonous drags - ядовитые лекарства prescription department -рщептурный отдел strong effective drugs - еыльнодейств. лек-ва cabinetf - шкаф для лекарств galenical preparations -галеновые препараты

to store - хранить to keep on the shelves - хранить на полках

refrigerator - холодильник to be in charge of - отвечать з

а8. Discuss the problem of clinical drug trials. What is your opinion on using animals for research? Should prisoners or sick people agree to participate in such trials?
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